Lipid-lowering drugs Flashcards
when should lipid lowering therapy be offered?
For primary prevention of CVD in people:
- aged <84 if QRISK assessment >=10%
- T2DM + other CVD risk factors
- T1DM
- CKD
- familial hypercholesterolaemia
- consider offering if age >=85
For secondary prevention of CVD in adults with established CVD, e.g. past or current Hx of MI, angina, stroke, TIA or PAD.
which investigations should be performed before initiation treatment?
- Full lipid profile: total cholesterol, HDL and non-HDL cholesterol and triglycerides
- LFTs - contraindicated in active liver disease
- renal function tests - dose adjustments required in CKD
- HbA1c - to Dx possible DM
- TSH - hypothyroidism is recognised cause of dyslipidaemia and untreated hypothyroidism increases risk of statin induced myopathy
- if pt has generalised unexplained muscle pain, measure CK levels - if 5x or more upper limit of normal, re-measure after 7 days; if still high, seek specialist advice.
which lipid modification therapies would you offer for primary and secondary prevention of CVD?
- Primary prevention:
- 1st line: 20 mg ATORVASTATIN - aim for >40% reduction in baseline non-HDL cholesterol
- 2nd line: reinforce adherence to lifestyle changes, consider increasing dose and if target still not achieved, consider co-prescription of EZETIMIBE in pts with primary hypercholesterolaemia - Secondary prevention: 80 mg ATORVASTATIN
what is the MOA of statins?
Inhibit HMG CoA reductase… decreased hepatic cholesterol synthesis.
suggest characteristic ADRs of statins
- myopathy: inc. myalgia, myositis, rhabdomyolysis and asymptomatic raised CK
- liver impairment: check LFTs at baseline, 3 mths and 12 mths (discontinue if ALT/AST rise to and persist 1 3x upper limit of reference range
what time of day should statins be taken?
At night as time is when majority of cholesterol synthesis takes place.
what is the MOA of ezetimibe?
inhibits cholesterol Rs on enterocytes, inhibition absorption from small intestine